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Lung diseases

Calcified Granulomata in Lungs

01/20/2011

Question:

5 years ago my husband had a medical problem ITP did not respond to plates given .Responded well to Gamamun treatment and prednisone .Has done wonderful has not had anymore trouble .Just recently had chest x-ray and CT scan show Calcified Granuloma in lungs and in liver and spleen . I have read that it could be from infections and fungus .TB neg. .My guestion in 2 months before this happened to my husband he had strep and also my concern is we remodeled and old home and could have come incontact with inhaling fungus into lungs is there any way in testing and is the fungus skill active.

Answer:

The short answer is that I would not worry about calcified granulomas and this is why. 

A granuloma is a form of inflammation in the body where immune cells encircle and form a "ball" around some type of infectious organism and hopefully clears away the infection. The usual types of infection that cause granulomas are funguses or mycobacterium, both of which could have been contracted if your husband was working in the soil or remodeling a house. Almost all fungal infections of this type resolve on their own without antibiotics. Once the infection is gone the granuloma usually goes away, but occasionally it stays, much like a scar. 

When the granuloma stays around, the body slowly deposits calcium into the granuloma as the scar matures. Because calcium is easy to see on an x-ray, we often (up to 25% of patients in Ohio) will see some calcified granulomas in the lung and also in other organs, especially the spleen. Often these granulomas appear as small nodules to the radiologist. They are benign and usually asymptomatic. The fact that they are calcified implies that they are old and most likely the infection has cleared. We would only be concerned about these nodules if they were 1) larger than usual or 2) causing your husband symptoms (shortness of breath and/or cough being the most common). 

Most often, if the granulomas are small and completely calcified, the radiologist will note them, but not recommend any further testing or follow-up. Ask you doctor if any further follow-up is needed in your husband's case. If the nodules are concerning, the radiologist will most often recommend to your doctor a follow-up CT scan to ensure that the nodules are stable, but as I said, this is only rarely needed. 

As far as the infection is concerned, as I mentioned above, the fact that they are calcified implies that the granulomas are old. From your description, I assume your husband is now off of his prednisone and other immune suppression. If he is not, you should double check my advice with his doctor. Many people in the midwest are infected with some of our more common funguses, especially Histoplasmosis, during their life and rarely do they even realize it. Most are without symptoms or may have thought they had a cold or bronchitis. 

In general, patients that are not on immunosuppression will recover from these infections spontaneously. We only recommend treatment with antifungal medications if you are experiencing symptoms such as shortness of breath, chest pain, fever/chills, night sweats, or weight loss. If your husband is otherwise feeling well I would not be concerned that he still has an active infection. 

Hope this helps. If you are still concerned about your husband's health or he does have any of the above symptoms, contact your doctor for a more thorough evaluation. 

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Response by:

Matthew  Exline, MD Matthew Exline, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University